NHS announce independent review of puberty blockers and cross sex hormones!

[rogdmum]

www.england.nhs.uk/2020/01/update-on-gender-identity-development-service-for-children-and-young-people/

Am pleased.

Who needs evidence when you have faith? I've been saying for a while that a. this is a religion and b. that means that everyone should have the legal right not to participate in it, and not to have laws based on it imposed upon them.

Who needs evidence when you have faith?

You are so right, Prodigal

Christ, if nothing else happens but this...the Tavi ought to have the most enormous slap on the wrist for their dreadful approach to follow ups and what happens when children leave their service. Can you imagine any other area in the NHS being like this? I am too tired and have had wine so cannot draw proper lines but I can’t imagine the uproar if we suddenly started “treating” children in any other area in the same way. Feel bad? Let’s render you infertile and cut bits off you. Seriously. After 3-5 appointments.

Two interesting tweets I saw last night

Very Interesting tweets Neuo. Informed opinion & actual facts can be so inconvenient sometimes.

I’ve been reflecting overnight and pondering the exctract Oldcrone posted upthread. an independent expert group is being established to make recommendations on the evidence, that will support a review of puberty suppressants and cross-sex hormones and whether changes are required to existing clinical policies that underpin the use of these on the NHS.

To unpick this, what were the hypotheses behind the clinical studies? What outcomes were they looking for?

If a medicine improves say lung function, the pharma companies might present data to show improved mortality and quality of life. For an anti-depressant, the data would look at improved ability to function, less anxiety etc.

So there is presumably data that shows puberty blockers delay puberty,
there might also be evidence that drug B is cheaper than drug A and has fewer side effects, but what questions were asked about why and was there ever a watch and wait control group?

The short version is we need to be asking why children are being given hormonal treatments, not which one is best.

The fundamental problem is it’s being done arse backwards. Puberty blockers weren’t started to relieve suicide. They were started by people who thought it was logical to stop puberty in someone who wanted to be the opposite sex.

It then moved on to say that trans kids are at risk of suicide.

It then moved on to say trans kids are at risk of suicide if they don’t get puberty blockers.

It then moved on to looking in retrospect at adults to see if they were more or less suicidal with puberty blockers (the recently published terrible article in Pediatrics).

It’s now looking at whether children who get puberty blockers do better with their mental health prospectively with a few studies but without control groups, with the Tavistock’s study that Michael Biggs took apart conveniently forgotten.

users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf

And eventually we may or may not get a proper RCT, depending on the ethics of it, by which stage the damage is already done to thousands of children worldwide.

In the meantime we get tweets - yes, Twitter is being held as the standard to which we treat our children now - that claim objecting to this experimental treatment means you want to “literally kill kids”.

It’s heartbreaking and infuriating in equal measure.

There’s never been a watch and wait control group. The Tavi feel such a control group would be unethical - pretty sure that’s in the Michael Biggs’ paper Old looked to earlier, but if not I can look for the source. In reality, the watch and wait control group exists, but it’s comprised of parents like me who wouldn’t get anywhere near the Tavi (well, I’m in Scotland, but same principle) and I wouldn’t trust GIDS enough to participate in one.

IMO, the only effective review would be one that takes a big step back and looks at the full process. At the moment, we have all these children/adolescents developing GI issues, many with GD. However, as soon as GI are raised within the NHS system, CAHMS won’t touch them or will stop seeing them as they have been referred to GIDS (generally speaking, there are some parents who manage to have help under CAHMS while on the GIDS waiting list).

So you now have all these children/adolescents stuck on 2 year+ waiting lists and unless the parents can afford private therapy (I’m itself very difficult to find therapists who take a neutral stance); no “help” other than organisations like Mermaids who are falling over themselves to push social transition. The children/adolescents then decide they need to socially transition, encouraged by social media, Mermaids etc, often school and/or their parents (who generally are scared and just want their child to be OK).

The longer they re socially transitioned, the more their GI issues/GD becomes embedded and they become convinced only blockers/hormones will relieve their symptoms. Finally they get seen by GIDS and are assessed, not through holistic counselling, but through counselling that focuses on GD.

It’s no wonder so many end up on puberty blockers and then, as we know, nearly 100% go onto cross sex hormones.

Until all of this is looked at (as well as the underlying causes for the initial GI issues/GD), the system will not be fixed.

This was put on Twitter last night and I thought is was an excellent diagram of the mental path taken by many.

twitter.com/radfemjourney/status/1223547706636931072?s=21

IMO, the only effective review would be one that takes a big step back and looks at the full process.

I agree rogdmum. I fear this won’t though.

That is a very pertinent graph given the way schools are being advised to affirm.

It leads to a 'commitment' to medical intervention.

Children and yp potentially face people accusing them of being fake or loosing hero status if they change their minds.

Lisa Littman has announced that she is going to do research into desisters/detransitioners. Just US based, but is good news.

c9281558-bf70-403c-912d-e9ffccc27472.filesusr.com/ugd/dfb146_2da98eec238943eb8ec9addf591b39f0.pdf

I think it’s fairly clear there’s a schism at the Guardian/Observer that goes beyond just the days of the week. This announcement was 3 days ago, nothing in the Guardian, as soon as the woke muppets leave the office, the Observer post an article on it. Same as last time with the Keira Bell case:

www.theguardian.com/society/2020/feb/02/gender-identity-treatments-for-young-expert-review

In the middle of tbe night, I had a health issue so I checked tbe nhs website. I was too busy resolving the health issue to screenshot this last night. But, health issue partially managed, I went back to check this morning. Apparently, sex is real when you are poorly.

Men are apparently more susceptible to viruses according to corona virus analysis, hence slightly more men have so far died.

Rogdmum - that graphic you posted is very powerful.

Clinics should be obliged to follow up on every single patient they discharge, up to 5 years afterwards. Otherwise how can they know how effective the treatment is?

In the meantime, this review could easily include a follow up review of a sample of discharged patients by an independent objective researcher. Especially those in the 18-28 year old bracket - which cover those discharged by the Tavistock at age 17/18.

Indecent reviews like this would restrict themselves to secondary research (systematic reviews of existing studies). They wouldn’t be doing primary research like followup studies of patients.

Indecent? Independent!

They could ask the clinics to demonstrate how they know that interventions are successful.

Apologies if this is a longish post.

I have been pleased to see some comments that members will respect the study results. That is good.

And it’s in remarkable contrast to the posts from members who plainly believe they know better than medical practitioners, trans individuals and trans children. Funny that, not unlike complaints that women should be allowed full control over their bodies.

Speaking as a fully transitioned trans woman, who has an entirely settled view of her gender identity since at least 12 years of age and can look back with the relative maturity of 56 years, I offer the following observations.

I would have been able to express my views clearly from at least 12. Use of puberty blockers and late teen transition would have avoided: (1) the indescribable pain of male puberty, (2) resolution of my ability to form real relationships at the age others could (I am straight.) (3) the loss of a beloved career through anti-trans discrimination in my 20’s and (4) one period of severe depression and 3 times in life when I seriously contemplated suicide (now behind me after transition in 2011).

I have been through the counselling required to allow access to medical transition under the WPATH guidelines and I entirely support proper psychological assessment of those proposing to undergo life changing surgery, and the need to study why (a tiny) proportion detransition.

But to say, as some contributors here do that (1) transition should not be available, (2) a ‘control group’ should be denied that help - code for being forced to go through the puberty they find so distressing - (3) children are being ‘experimented’ on, are a travesty.

Be, oh so careful with allying with the religious right who, for example, also ‘know best’ about abortion rights.

And organisations like ‘Transgender Trend’, apparently run by those who understand their own prejudices so well - but little about what it is to be trans - would be best to be honest that they are a pressure group promoting prejudice and stop masquerading as advice organisations.

I would have been able to express my views clearly from at least 12. Use of puberty blockers and late teen transition would have avoided: (1) the indescribable pain of male puberty

But on the plus side, you’ve (presumably) been able to enjoy sexual function and a healthy enough sex life, plus fertility (if you have a family), and your bone density is normal and you haven’t had your risk of stroke significantly increased.

(2) resolution of my ability to form real relationships at the age others could (I am straight.)

What does straight mean here? Hard to know. Do you mean you’re attracted to males? How sure can you be that puberty blockers would have solved this problem?

(3) the loss of a beloved career through anti-trans discrimination in my 20’s

How? Are you saying the only way to resolve anti-trans discrimination is to make sure all trans people pass by having their bodies altered at puberty? Wouldn’t it be better to alter society rather than the healthy bodies of children?

one period of severe depression and 3 times in life when I seriously contemplated suicide (now behind me after transition in 2011)

You have no way of knowing whether you would or wouldn’t have suffered significant depression when the realisation of never having a functioning sex life would have hit you, or realising that despite the physical alterations to your body you still felt dysphoric, or the mental suffering associated with complications of surgery done on pre-pubertal tissue.

a ‘control group’ should be denied that help - code for being forced to go through the puberty they find so distressing

It’s perfectly possible these children will end up better off in the long run. You don’t know. No one knows. That’s why it’s an experiment.

Why, as a trans person, do you think children with gender identity issues should be subject to a level of medicine with lower rates of evidence than the rest of the population?

Why do you assume that people who are against this are part of the “religious right”? I’m an atheist who votes to the left. So how does that work?

Robin what you are failing to take into account is that left alone, about 80% of children suffering from gender dysphoria will desist after puberty. Put simply that means that for every child who is like you, there will be about 4 who no longer identify as transgender as adults.

When presented with 5 children, all with the same symptoms of gender dysphoria, how do you know which is the one whose dysphoria will persist after puberty?

Treating all of them with puberty blockers is doing harm to the four who would desist after puberty, and it's by no means certain that it is not doing harm to the one who might persist.

Use of puberty blockers and late teen transition would have avoided: (1) the indescribable pain of male puberty,

But you would not have been able to have GRS with a child-size penis.

(2) resolution of my ability to form real relationships at the age others could (I am straight.)

What stopped you forming relationships? When you say you are 'straight' does that mean you're attracted to men? Saying you couldn't form relationships sounds a bit homophobic.

But to say, as some contributors here do that (1) transition should not be available, (2) a ‘control group’ should be denied that help - code for being forced to go through the puberty they find so distressing - (3) children are being ‘experimented’ on, are a travesty.

Children should not be transitioning. They are being experimented on. The Tavistock know this, which is why they were supposedly doing their 'early intervention study' (whose results have still not been released).

Nobody is 'forced' to go through puberty. It's a natural process. Stopping it happening at the normal age is unnatural and a cruel experiment on children.

Finally Robin, I asked you on another thread to define exactly what you mean by 'gender identity'. Will you give me that definition now?

Be, oh so careful with allying with the religious right

I'm not allying with the religious right. I have formed my own opinions and I take no responsibility for any other person or group who might share any of my opinions, nor do I necessarily agree with any other person or group on any other issue simply because we may agree on one particular point.

Ah Robin whilst pronouncing on the law you can rely on your legal credentials, you cannot do so when it comes to medical knowledge. There are medical researchers on here with far more knowledge in this area than you.

I will not ‘respect the study results’; I will do what any scientist would do and critically appraise them. We know little research exists in many areas of transideology so it is likely that the conclusions of any such study will have to be heavily qualified.

You also exhibit a shocking disregard for children. But of your own story, had you been put on puberty blockers it is likely that you would have increased your self-harming and suicidal thoughts, you would have been left sterile, with no sexual function and low bone density. You would also still have been denied your career due to the fact that your IQ would have been reduced by 10 IQ points.

Robin I am reading your post and doing my best to take it in.

The hardest thing to accept about chemotherapy for normal development for me is that it is not doing nothing. On blockers you would not have experienced an absence of male puberty, but a forced halting of normal development while all your peers were going through it. This is an intervention of truly earth shaking proportions for children. I am really struck by the fact that even Dr Olsen Kennedy doesn't like putting children on these drugs. Even she thinks they are something to be on for as short a time as can possibly be achieved.

If this study truly addresses how we know whether and who this treatment could possibly benefit, I will indeed accept it. It is hard to see how it could honestly conclude that it does, given that as you say the only control group ethically available is the vast number of children who in previous generations did not exhibit any desire to change sex, though plenty of distress at puberty for all kinds of reasons.

Without RCTs, we cannot show causation, only correlation which may be due to confounding.

Robin, you say you felt relief when you had surgery, you do realise that had you been on blockers, that surgery either could not happen or would have many complications.